Healthcare Provider Details

I. General information

NPI: 1043070808
Provider Name (Legal Business Name): MINDFUL NEUROLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 SAPPHIRE RD
MONROE NY
10950-5539
US

IV. Provider business mailing address

PO BOX 426
HARRIMAN NY
10926-0426
US

V. Phone/Fax

Practice location:
  • Phone: 516-884-2442
  • Fax: 917-477-6456
Mailing address:
  • Phone:
  • Fax: 917-477-6456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SARAH MULUKUTLA
Title or Position: PHYSICIAN / OWNER
Credential: MD
Phone: 516-884-2442